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Hemostasis biomarkers and incident cognitive impairment: the REGARDS study
S R Gillett1, L A McClure2, P W Callas1
1Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Insights
Elevated hemostasis biomarkers like fibrinogen and D-dimer are linked to cognitive impairment risk. Having two or more abnormal markers significantly increases the likelihood of developing cognitive impairment over time.
Area of Science:
- Neurology
- Vascular Biology
- Biomarkers
Background:
- Cognitive disorders are a growing public health concern, with vascular risk factors playing a significant role.
- Understanding the link between hemostasis and cognitive impairment is crucial for early detection and prevention.
Purpose of the Study:
- To investigate the association between hemostasis biomarkers and the risk of incident cognitive impairment.
- To determine if specific hemostasis markers or a combination of markers predict cognitive decline.
Main Methods:
- A nested case-control study was conducted within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
- 1082 participants (free of stroke/cognitive impairment at baseline) were followed for 3.5 years.
- Baseline levels of D-dimer, fibrinogen, factor VIII, and protein C were measured, and cognitive impairment was assessed using multiple tests.
Main Results:
- Individually, elevated D-dimer, fibrinogen, and factor VIII were not significantly associated with incident cognitive impairment after multivariable adjustment.
- However, participants with two or more abnormal hemostasis biomarkers showed a significantly higher risk of developing cognitive impairment (adjusted OR 1.73).
- No differences in associations were observed based on race or region.
Conclusions:
- While single elevated hemostasis biomarkers may not predict cognitive impairment, a higher burden of these markers is associated with increased risk.
- These findings suggest that the combined effect of hemostasis dysregulation is relevant to cognitive decline.
- Further research into the role of hemostasis in cognitive health is warranted.
Abstract:
Essentials Cognitive disorders are increasing and vascular risk factors play a role in this. We performed a nested case control study of hemostasis biomarkers and cognitive impairment (CI). Higher baseline fibrinogen, factor VIII and D-dimer were related to incident CI over 3.5 years. Adjusted for other risk factors, 2+ abnormal markers (but not single ones) led to higher risk.
Summary:
Background Vascular risk factors are associated with cognitive impairment, a condition that imposes a substantial public health burden. We hypothesized that hemostasis biomarkers related to vascular disease would be associated with the risk of incident cognitive impairment. Methods We performed a nested case-control study including 1082 participants with 3.5 years of follow-up in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a longitudinal cohort study of 30 239 black and white Americans aged ≥ 45 years. Participants were free of stroke or cognitive impairment at baseline. Baseline D-dimer, fibrinogen, factor VIII and protein C levels were measured in 495 cases who developed cognitive impairment during follow-up (based on abnormal scores on two or more of three cognitive tests) and 587 controls. Results Unadjusted odds ratios (ORs) for incident cognitive impairment were 1.32 (95% confidence interval [CI] 1.02-1.70) for D-dimer > 0.50 μg mL-1 , 1.83 (95% CI 1.24-2.71) for fibrinogen > 90th percentile, 1.63 (95% CI 1.11-2.38) for FVIII > 90th percentile, and 1.10 (95% CI 0.73-1.65) for protein C < 10th percentile. There were no differences in associations by race or region. Adjustment for demographic, vascular and health behavior risk factors attenuated these associations. However, having at least two elevated biomarkers was associated with incident cognitive impairment, with an adjusted OR of 1.73 (95% CI 1.10-2.69). Conclusion Elevated D-dimer, fibrinogen and FVIII levels were not associated with the occurrence of cognitive impairment after multivariable adjustment; however, having at least two abnormal biomarkers was associated with the occurrence of cognitive impairment, suggesting that the burden of these biomarkers is relevant.
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